The Perilous Public Option

The latest Washington Post-ABC News poll highlights the potential political impact - both positive and negative - of the battle over what has come to be known as the public option, a government-created health insurance plan to compete with private insurers.

Such a plan adds to the challenge of passing a bill over which the public is sharply divided: In a twist, although more say they support a public option (55 percent) than say they back the "proposed changes to the health care system being developed by Congress and the Obama administration" (46 percent), if the public option were taken off the table, support for the rest of the reform package edges up to 50 percent.

How so? Simply put: In the poll, the vast majority of those who support the entire reform package also back it without the public option, while removing it attracts some of those who would otherwise be opposed. (See here.)

But the political calculation is hardly straightforward.

Support for a public option itself varies widely by its scope and perceived effect, giving both substance and spin staring roles in its politics. In this poll, were the option limited to those unable to get coverage elsewhere, support would jump to 76 percent, whereas in previous polls support crumbled when people were asked what if it meant some private insurers would go out of business, as Republican leaders claimed.

Here are other data points from the poll worth considering in trying to parse through public attitudes on this complex subject:

Most of those who support a public option would still support reform even if the plan didn't include a government-sponsored insurance option (64 percent). On the other hand, nearly the same number of those who oppose the public option (63 percent), say they'd still oppose the plan even if a government option is taken out of consideration.

Among independents, intensity of opinion tilts against a public option (28 percent strongly support it, 35 percent strongly oppose it), and taking it off the table moves a 12-point margin against the Democratic health reform proposals (40 percent support vs. 52 percent oppose) into a 45 to 45 percent tie.

The gains Obama would make with liberal Democrats (88 percent support the health reform plan overall, higher than the 81 percent who would back it if it lacks a public option) by including a public option are smaller than the potential inroads with conservative Republicans by removing it (support climbs from a meager 5 percent to 25 percent).

In the poll, removing the public plan from the package increases support among those who claim detailed knowledge of the proposals (among those who say they know "a great deal," support climbs from 40 to 47 percent, support among those who claim "a good amount" of knowledge moves from 52 to 57 percent).

Broad majorities across party lines (76 percent overall) say they would support a public option if it were limited only to those who, "cannot get health insurance from a private insurer." Support for that type of public option includes 94 percent of Democrats, 73 percent of independents and 59 percent of Republicans.

More than seven in 10 say Obama and the Democrats in Congress should try to change the health care reform bill in order to win some Republican support, that figure includes 65 percent of those who support a public option and 81 percent of those who are opposed.

Coming back to those midterm elections next year, for a majority of all but the strongest opponents of a public option, a candidate's position on the reform bill will not have much of an effect on their vote. But among those strongly opposed to a public option, 55 percent say they would be more likely to oppose a candidate who supported the health care bill (including 45 percent who would be "much more" likely to oppose that candidate). Among strong supporters, 43 percent say they would be more apt to support a candidate who backs the bill.

As far as I can tell, there isn't any specific information on these reform bills. In street language, that indicates that the devil is in the details. We will be forced to live with whatever sneaks into the legislation. I recently had to go to an emergency room with three cracked ribs. I was observed for about 15 minutes while the ER Doc gave me a couple packets of those pills the drug companies give them for free. I was told nothing could be done, scheduled for Xrays, cautioned about lifting, told to see my physician, bla bla blah. I don't have a problem with my treatment, I knew there was nothing that could be done save look me over. My fury came later when I saw how much my Insurance Company had to pay! Services rendered did not come close to the $1500+ that I was charged! Can we please stop the political BS and get to the root of the greed inour medical system. This is another case of corporate vampirism. If not government regulation, then who? Some of you people sit out there and regurgitate everything the RP tells you, they push the anger button and you jump like frogs, they push the hate button and you spew trash and lies. They push the fear button and you wet your pants. You know what? I'm not afraid. I'm ready for the future, I'm following somebody with some courage, vision and the resolve to follow through on difficult issues. Has it occurred to anyone that the RP is composed of the wealthy interests that stand to lose the most if the Healthcare system is reformed. Who do you thing had the oppurtunity and motive to slowly make it evolve to the point where they can charge me $1500 for an office visit? Do you think the government caused that? Citizens need to think their way through this crap. Private interest will definately sucker punch you, at least we have a chance to oversite with the government, it is not a perfect America, but it is my America.

Many other industrialized countries have National health care systems that work well and provide better outcomes. The only thing holding America back is aggressive right wing ideology and Corporate resistance.

More than 2 out of 3 doctors think we should have a public option. There are many solutions out there. Ignore the lunatics on the right and get this done.